DEAR MAYO CLINIC: My mother was recently diagnosed with breast cancer. Given my family history, when should I consider preventive surgical options, and what do those look like? Are there other risk factors I should be aware of? 

ANSWER: Given your family history, it's understandable to think proactively about your breast cancer risk. The good news is that today we have more tools than ever to help people understand their personal risk and choose prevention strategies that fit their goals, health needs and stage of life. 

An important first step is meeting with a healthcare clinician experienced in breast cancer risk assessment, such as a breast health specialist at a high-risk breast clinic. Clinicians use a combination of personal history, family history, genetic testing and validated risk-prediction models to estimate your lifetime risk of developing breast cancer. 

What factors increase breast cancer risk?

Risk factors may include: 

• Age. 

• Genetic mutations, such as BRCA 1 or BRCA 2. 

• Family history of breast or ovarian cancer. 

• Hormonal factors, including age at first menstrual period, pregnancy history and breastfeeding. 

• Prior breast biopsies or certain benign breast conditions. 

• Breast density on imaging. 

Reviewing risk, family history and any genetic results of family members with a genetic counselor may be helpful to determine whether genetic testing may be appropriate for you. 

Once your risk is better defined, your care team can recommend a personalized screening plan. For people at higher risk, this may include earlier and more frequent screening, often using breast MRI or other imaging options in addition to mammography. 

What are the options for reducing breast cancer risk?

Prevention strategies generally fall into three categories: 

Lifestyle approaches. Maintaining a healthy weight, staying physically active, limiting alcohol intake and avoiding smoking can help reduce breast cancer risk. Research shows that combining regular aerobic exercise with strength training offers the most significant benefit. 

Risk-reducing medications. Certain medications can lower breast cancer risk by about 50%-70% in select people. These are typically taken daily for several years and may be an option depending on your age, menopausal status and individual risk profile. 

Risk-reducing surgery. For some people at very high risk, including those with BRCA mutations, preventive surgery may be considered. A bilateral (double) mastectomy can reduce the risk of developing breast cancer by approximately 90%-95%, although no surgery can eliminate risk entirely. This is a permanent decision that affects appearance, sensation and quality of life, so it’s essential to carefully discuss this with your care team. 

When should preventive mastectomy be considered?

Risk-reducing mastectomy can be performed with or without breast reconstruction. There are different approaches to both mastectomy and reconstruction, and eligibility for a particular approach will be discussed by your care team. Options include: 

• Total mastectomy, which removes the breast tissue and results in a flat chest wall. 

• Skin-sparing mastectomy, which preserves most of the breast skin. 

• Nipple-sparing mastectomy, which preserves the skin and nipple-areola complex for select patients. 

Robotic-assisted nipple-sparing mastectomy can also be an option for select patients with increased risk of breast cancer who are considering a prophylactic (preventive) mastectomy. This approach also may be used for patients who have early-stage breast cancer with tumors located away from the nipple and skin. 

The minimally invasive approach allows the surgeon to remove breast tissue through a small incision near the side of the breast under the arm while preserving the skin and nipple-areola complex. Early experience suggests this technique may reduce visible scarring, improve cosmetic outcomes and improve patient-reported outcomes, such as postoperative physical well-being, while maintaining the same cancer-control principles as other surgical options.  

Ongoing evaluation and research continue to refine patient selection and outcomes for this innovative technique. 

How do you decide which prevention option is right for you?

Choosing whether, and when, to pursue medication or surgery to reduce breast cancer risk is a deeply personal decision. It also can change over time as circumstances evolve. Factors such as age, menopausal status, plans for pregnancy, family responsibilities and personal values all matter. 

Meeting with a breast surgical oncologist, genetic counselor and reconstructive plastic surgeon can help you fully understand your options and feel confident in your decision. 

Being proactive about your health is an important step. With individualized care and a thoughtful approach, you and your healthcare team can develop a plan that best supports your long-term well-being. 

Jeffrey E. Johnson, M.D., Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota, and Mara Piltin, D.O., Surgical Oncology, Mayo Clinic, Jacksonville, Florida

The post Mayo Clinic Q&A: When to consider preventive breast cancer surgery appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Researchers in a Mayo Clinic-led study have shown how to detect a broad range of DNA mutations in noncancerous human tissues and across the genome. The analysis, drawing on more than 90 trillion DNA letters of sequencing data, could help scientists study when these changes arise — from early development through aging — and how they contribute to cancer and other diseases. 

Published in Cell, the study is the flagship paper in a package of roughly a dozen publications from the National Institutes of Health (NIH) Common Fund's Somatic Mosaicism across Human Tissues, or SMaHT, Network. The network includes more than 300 members from more than two dozen U.S. universities and hospitals. Researchers evaluated approaches for detecting somatic mutations ranging from single-letter DNA changes to large deletions, insertions and rearrangements. 

Alexej Abyzov, Ph.D., a Mayo Clinic professor of biomedical informatics who leads the Somatic Mutations in Development and Aging Laboratory, is the corresponding author of the Cell study. 

Reading the cellular mosaic

Unlike inherited genetic changes, somatic mutations arise after conception and accumulate over a lifetime. As cells divide, they can pass those changes to new cells, creating genetic differences within the same person, known as somatic mosaicism. Some somatic mutations can alter how cells behave and contribute to cancer, aging, and neurodevelopmental, cardiovascular and autoimmune diseases. 

These mutations can be difficult to detect when they are rare or occur in complex, repetitive regions of the genome. The SMaHT Network compared short- and long-read whole-genome sequencing, duplex sequencing, single-cell sequencing, and computational approaches. 

One of the clearest findings came from long-read sequencing, which reads longer stretches of DNA at a time. Much like reading a full sentence instead of a few scattered words, the added context made large genetic changes easier to find. Long-read sequencing detected about twice as many large DNA changes as short-read sequencing. It also found insertions that shorter reads often missed. 

Researchers improved detection in other hard-to-read parts of the genome too. In one benchmark, a more complete genome reference raised precision from 79% to 89%. Single-cell sequencing of 102 lung and colon cells revealed differences from cell to cell and helped trace their history back to early development. 

Companion study maps rare mutations across tissues

Dr. Abyzov also co-led a companion SMaHT paper published in The American Journal of Human Genetics. Deep whole-genome sequencing accurately detected rare, single-letter DNA changes present at levels below 1% in a tissue sample. 

Analyzing DNA from different organs also helped detect mutations that arose early in development and spread to multiple tissues. Combining lung and colon data uncovered 13 additional shared mutations, improving detection by 145% for these very rare mutations compared with analyzing either tissue alone. 

SMaHT aims to catalog somatic mutations across 10 to 15 tissue types from 150 donors while improving the tools used to detect them. NIH is planning a second stage focused on understanding how these mutations influence biological processes and disease. 

Dr. Abyzov says the research could eventually help identify people at higher cancer risk and track precancerous changes in tissues before developing symptoms.  

The studies were supported by the NIH Common Fund through the Office of Strategic Coordination in the NIH Office of the Director. The companion study received additional NIH support for work conducted at Mayo Clinic. For complete author lists, disclosures and funding information, review the Cell study and the companion The American Journal of Human Genetics study. 

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About Mayo Clinic   
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.   

Media contact:    

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu 

The post Large-scale study advances detection of DNA mutations across the human genome  appeared first on Mayo Clinic News Network.

October is Breast Cancer Awareness Month

ROCHESTER, Minnesota — You probably know that a lump in the breast may be a symptom of breast cancer. But what about breast cancer that develops without that warning sign? Inflammatory breast cancer is a fast-moving cancer that doesn't usually form a lump; instead, the skin on one breast changes rapidly, explains Tina Hieken, M.D., a surgical oncologist at Mayo Clinic Comprehensive Cancer Center.

Inflammatory breast cancer often comes with symptoms that mimic inflammation of the breast, such as a change in skin color to a pink, red, purple or bruised appearance, unusual warmth in the affected breast, and orange peel-like skin, a symptom known as peau d'orange.

As a result, inflammatory breast cancers may be misdiagnosed as cellulitis, mastitis, Paget’s disease of the breast, or other more benign conditions.

Inflammatory breast cancer accounts for roughly 1% to 5% of breast cancer diagnoses but 10% of breast cancer deaths, statistics show.

"When there are changes in the skin of the breast, particularly in women who aren't nursing and do not have breastfeeding-associated redness, that can be a warning sign of cancer and should be evaluated by a medical professional," Dr. Hieken says.

"In inflammatory breast cancer, symptoms can develop within a few months," she notes. "That's different from someone noting a lump in the breast over a period of time, and then secondarily, skin changes in the breast over a year or longer."

In inflammatory breast cancer, abnormal cells go through the lymphatic channels in skin and soft tissue, accounting for the skin changes in the breast, Dr. Hieken explains.

Inflammatory breast cancer treatment

Inflammatory breast cancer is treated first with systemic therapy: a treatment that goes through the whole body, she says. That therapy is based on the cancer's biological features, or subtype, such as whether it expresses the estrogen receptor or overexpresses the HER2 protein.

The systemic therapy is usually delivered intravenously and could be:

• Chemotherapy directed at rapidly dividing cells.
• Targeted therapy aimed at cells that overexpress the HER2 protein.
• Immunotherapy to help the body fight cancer that doesn't express the estrogen receptor or the HER2 protein; this is the least common type, Dr. Hieken says.

Then, surgery includes removal of the breast and  nearby lymph nodes, typically followed by radiation that includes the chest, armpit and shoulder. This three-mode approach of whole-body therapy, surgery and radiation is critical to disease control for cancer that has a high risk of spreading to other parts of the body or recurring in the breast and surrounding area, Dr. Hieken says. More common forms of breast cancer may not require all types of available treatments.

Advances in inflammatory breast cancer care

There have been several innovations in the treatment of inflammatory breast cancer.

"Very similar to non-inflammatory breast cancer, giving treatment at the beginning that is designed for one of those three or four subtypes of breast cancer is probably the biggest innovation," Dr. Hieken says. "I think in parallel, the other big innovation is better cross-sectional imaging so that, at the outset, we know whether patients have disease that has spread beyond the breast and the regional lymph nodes."

Among the breast cancer subtypes, progress has particularly been made in HER2-positive inflammatory breast cancer, with the addition of two different drugs that work in a complementary way to block the effects of the HER2 protein overexpression, she adds.

"It's been a huge advantage and has really improved outcomes for women," Dr. Hieken says. "Then, for those women who have less than a complete response to that systemic treatment, there are new targeted therapies that can be given after surgery."

Another improvement is intensity modulated radiotherapy, or IMRT, that is delivered using CT integrated planning, she says. This allows the care team to look at a patient in three dimensions and determine how to personalize radiation therapy to minimize the effects through such techniques as having the patient practice breath-holding or lie on her stomach during radiation therapy.

"We're learning a lot," Dr. Hieken adds.

A team approach to inflammatory breast cancer treatment

At Mayo Clinic, physicians from across treatment disciplines work alongside researchers seeking new care options for patients with this aggressive form of cancer.

Specialists from medical oncology, radiation oncology, surgical oncology and radiology work together. They collaborate with additional healthcare professionals such as genetic counselers, pathologists, social workers, occupational and physical therapists, psychotherapists, and integrative medicine experts, to offer comprehensive support to patients.

For more information about inflammatory breast cancer, visit mayoclinic.org and the Mayo Clinic Medical Professionals website.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post Inflammatory breast cancer: Fast-moving form often lacks lump as warning sign appeared first on Mayo Clinic News Network.

When part of the liver is removed to treat cancer or other conditions, the remaining tissue must regenerate to restore liver function.  

In this Mayo Clinic Minute, Dr. Patrick Starlinger, a hepatobiliary and pancreas surgeon at Mayo Clinic Comprehensive Cancer Center, discusses research to help the liver regenerate after surgery. 

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:07) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

How does the liver regenerate after surgery?

"The liver can regenerate quite dramatically, probably the most potential to regenerate in the entire human body, and we leverage this in liver surgery," says Dr. Starlinger.  

Before surgery, the team measures liver volume and assesses liver function to determine how much can be safely removed to take out the tumor while leaving enough healthy liver to regenerate.  

But in some patients, that regeneration does not happen, which can lead to liver failure and limit which tumors can be removed.  

"Our area of research is so important to understand the mechanism of liver regeneration in humans, particularly because as we understand the mechanism, we can move forward with interventions to promote regeneration in these patients," says Dr. Starlinger.  

What role does blood clotting play in liver regeneration?

Mayo Clinic researchers have analyzed liver samples from patients with healthy livers and those with underlying liver conditions to better understand what drives regeneration.   

"We were able to discover that the blood coagulation system is crucially important to allow these mechanisms of liver regeneration to actually occur," says Dr. Starlinger.     

More research is needed, but researchers hope these findings could eventually lead to treatments that promote liver regeneration and expand the limits of liver surgery.

The post Mayo Clinic Minute: Unlocking how the liver regenerates after surgery (VIDEO) appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My spouse was recently diagnosed with a blood cancer, and we're overwhelmed by everything we're being told. What should patients and families expect after a diagnosis, and how do doctors determine the right treatment? 

ANSWER: A blood cancer diagnosis can bring a lot of information and uncertainty all at once. In the first days and weeks, you may meet with specialists and undergo several tests as your healthcare team learns more about your cancer and plans your care. 

It can feel like treatment should begin immediately, but one of the most important first steps is getting the diagnosis right. Blood cancers such as leukemia, lymphoma and multiple myeloma have different types and subtypes that can behave and respond to treatment differently. 

A pathology review is a key part of this process. A pathologist examines blood, bone marrow or tissue samples to look for features that help identify the cancer. For complex or uncommon cases, having someone with extensive experience diagnosing blood cancers review the samples can provide valuable insight. 

Additional testing may look more closely at the cancer's characteristics, including changes in its chromosomes or DNA. These changes are found in the cancer itself and are not necessarily inherited. They can help your healthcare team understand how the cancer may behave and guide decisions about your care. 

How are blood cancers treated?

Not every blood cancer needs to be treated immediately. An acute leukemia, for example, generally requires urgent care, while some chronic leukemias or slow-growing lymphomas may be monitored until treatment is needed. 

Treatment options for blood cancers may include: 

• Chemotherapy.  

• Immunotherapy.  

• Targeted therapy.  

• Radiation therapy.  

• Stem cell transplant.  

Which treatment is recommended depends on the type and behavior of the cancer. Your healthcare team also considers your age, overall health, other medical conditions, possible side effects and practical considerations, such as how often you'll need to travel for treatment.  

Clinical trials are research studies that help researchers learn more about new or existing approaches to care. They can be considered at different points in the care process. A common misconception is that clinical trials are only an option when standard therapies have stopped working. Some trials are available at the time of diagnosis, and they may study new approaches or ways to reduce the intensity or side effects of existing therapies. 

If you're considering a clinical trial, ask what is already known about its safety, how often you'll need appointments, how long participation lasts and whether assistance is available for expenses such as travel or lodging. 

Blood cancer care often takes a multidisciplinary team. Specialists in areas such as hematology, pathology, radiology and radiation oncology may work together when making treatment decisions. This collaboration helps them consider your cancer, other health conditions and potential complications. 

During and after treatment, you may hear several terms used to describe the status of your cancer: 

• Response: Testing shows the cancer is decreasing in some way.  

• Remission: There is no evidence of cancer based on the tests used to detect it, but this does not necessarily mean the cancer is cured.  

• Disease control: The cancer isn't growing, even if it hasn't disappeared.  

• Recurrence: The cancer has returned after a period of remission.  

Follow-up depends on the type of blood cancer and care you've received. It may include physical exams, blood tests, imaging or bone marrow biopsies. Your healthcare team also will monitor for potential long-term effects related to your cancer and its treatment, including cardiovascular problems and the risk of developing other cancers. 

After a blood cancer diagnosis, you don't have to understand everything at once. Ask questions, bring a family member or friend to appointments if it helps, and take time to learn about your diagnosis and options. Having the right information can help you feel more prepared for the decisions ahead. 

Urshila Durani, M.D., Hematology, Mayo Clinic, Rochester, Minnesota.

Join the conversation on Mayo Clinic Connect Blood Cancers & Disorders Support Group.

The post Mayo Clinic Q&A: What should you know after a blood cancer diagnosis?  appeared first on Mayo Clinic News Network.

Landmark ATOMIC trial brings immunotherapy to patients being treated with the goal of cure

ROCHESTER, Minn. — The Food and Drug Administration (FDA) has approved the immunotherapy drug atezolizumab in combination with chemotherapy for some patients with stage 3 colon cancer following surgery. The treatment is for patients whose tumors have deficient DNA mismatch repair, or dMMR.

The approval is based on results from the ATOMIC clinical trial led by Mayo Clinic. The study found that adding atezolizumab to standard chemotherapy reduced the risk of cancer recurrence or death by 50% compared with chemotherapy alone. FDA approval further establishes the addition of immunotherapy to chemotherapy as a standard treatment option in the curative setting and helps to make it more readily accessible to patients who may benefit.

"This approval represents a major advance for patients with a subset of stage 3 colon cancer," says Frank Sinicrope, M.D., a Mayo Clinic oncologist and leader of the ATOMIC study. "ATOMIC is the first study to show the benefit of immunotherapy after surgical resection in patients with locally advanced colon cancer with dMMR. The goal after surgery is to eliminate remaining microscopic cancer cells responsible for recurrence and thereby increase the number of patients who are cured of their disease."

The phase 3 ATOMIC trial enrolled 712 patients with stage 3 dMMR colon cancer that had been surgically removed and spread to regional lymph nodes. Patients were randomly assigned to receive standard chemotherapy alone or chemotherapy combined with atezolizumab, an immune checkpoint inhibitor, followed by additional atezolizumab.

At three years, 86.3% of patients who received immunotherapy plus chemotherapy were alive and free of disease, compared with 76.2% of patients who received chemotherapy alone. The findings were published this year in The New England Journal of Medicine.

Moving immunotherapy earlier in treatment

Immune checkpoint inhibitors have transformed the treatment for several advanced cancers. In colon cancer, they have been particularly effective against tumors with dMMR. These tumors have a defect in their ability to properly repair errors in their DNA during cell division, leading to the accumulation of multiple mutations that can make the cells more recognizable to the immune system.

Before the ATOMIC trial, immunotherapy was used primarily for advanced or metastatic dMMR colorectal cancer. ATOMIC examined whether activating the immune system after surgery that is intended to cure the patient could prevent cancer from returning.

"Instead of waiting until a patient's colon cancer has returned or spread, we can now use immunotherapy earlier when patients have undergone surgery and are able to prevent or markedly reduce the chance of recurrence," Dr. Sinicrope says.

Approximately 15% of colon cancers have dMMR. Testing a patient's tumor can identify dMMR and help determine the optimal treatment.

An important advance for younger patients

The approval also comes as colorectal cancer rates among younger adults continue to rise. More than one-quarter of patients enrolled in ATOMIC were younger than 50.

The trial included patients with Lynch syndrome, the most common inherited cause of colorectal cancer and the most common hereditary cancer syndrome. People with Lynch syndrome have an increased risk of developing several cancers, particularly colorectal cancer, and frequently develop cancer at younger ages. Colon cancers associated with Lynch syndrome generally have dMMR.

"For patients who develop colon cancer at a young age, preventing recurrence can translate into decades of life gained," Dr. Sinicrope says. "Being able to offer an effective treatment such as immunotherapy to improve the survival of these patients is especially meaningful for them and their families."

From scientific insight to a new treatment

ATOMIC grew from years of research into the biology of dMMR colon cancer. Dr. Sinicrope and colleagues previously observed that these tumors contain large numbers of inflammatory and immune cells, including those cells targeted by immune checkpoint inhibitors. Those findings provided the scientific rationale for testing whether immunotherapy could strengthen the body's immune response against cancer cells that can remain after surgery.

Dr. Sinicrope developed the study, which was conducted through the Alliance for Clinical Trials in Oncology, part of the National Cancer Institute-supported National Clinical Trials Network. Patients from the U.S. and Germany participated.

"The patients who participated in ATOMIC made this advance possible, and their contribution will change how we treat patients with dMMR colon cancer here and around the world," says Dr. Sinicrope.

The National Comprehensive Cancer Network previously updated its guidelines to include atezolizumab plus chemotherapy as a treatment option based on the ATOMIC findings. FDA approval establishes the regimen as an approved treatment for eligible patients in the U.S.

The National Cancer Institute of the National Institutes of Health and Genentech funded the ATOMIC study. See the study in The New England Journal of Medicine for a complete list of authors, disclosures and funding.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post FDA approves immunotherapy regimen studied by Mayo Clinic for stage 3 colon cancer appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My doctor told me my cancer has spread to my brain. What treatments are available, and what should I expect next? 

ANSWER: Brain metastases, sometimes called "brain mets," occur when cancer that began elsewhere in the body spreads to the brain. 

Treatment may include surgery, focused radiation, whole-brain radiation, medicines or a combination of these approaches. There's no single treatment plan that's right for everyone. Your healthcare team may recommend an individualized plan based on many different factors. 

How do doctors decide which treatment is right for you?

Brain MRI scans will help your care team assess the size, location and extent of brain metastases. Treatment planning also depends on several other considerations, including: 

• The number of tumors. Your team will determine whether there is one brain metastasis, a few or many. 

• Their size and location. A tumor's position may affect whether it can be removed safely and whether it's pressing on an area that controls an essential function. 

• Your symptoms. Brain metastases may cause headaches, seizures, weakness, confusion or other symptoms. 

• Cancer elsewhere in the body. Your team will consider whether cancer outside the brain is controlled or progressing. 

• The tumor's molecular features. These are the specific genetic characteristics of cancer. Understanding them may help your team predict how the cancer could behave and identify treatments that may work. 

• Your priorities. Your goals and quality of life are important parts of treatment planning. 

When is surgery recommended for brain metastases?

Surgery may be considered when a brain metastasis can be safely reached and removing it fits into your overall cancer treatment plan. It may be recommended when a tumor is large, is causing pressure in the brain, is producing symptoms that require relief, or when tissue is needed to confirm the diagnosis or perform molecular testing. 

The surgical approach depends on the tumor's size and location. Some tumors may be treated using minimally invasive techniques. If a tumor is near an area that controls speech, movement or another essential function, awake brain surgery may allow the surgical team to monitor those functions during the procedure. 

How is radiation therapy used to treat brain metastases?

Radiation therapy uses powerful beams of energy to destroy cancer cells. The type of radiation recommended depends on factors such as the number and location of the tumors, whether surgery is part of the plan, whether medicines may help control the cancer, and how treatment could affect your quality of life. 

• Stereotactic radiosurgery is commonly used to treat brain metastases. Despite its name, it doesn't involve an incision. It delivers highly focused radiation to specific areas of the brain while limiting exposure to nearby healthy tissue. Treatment often is completed in one or a few sessions. 

• Whole-brain radiation treats the entire brain and may be considered when cancer is more widespread within the brain.  

Can medicines treat cancer that has spread to the brain?

Systemic therapies are medicines that travel through the bloodstream to treat cancer throughout the body. They include chemotherapy, immunotherapy, targeted therapies and other cancer medicines. 

In the past, brain metastases often were treated first with surgery or radiation because many cancer medicines had difficulty reaching tumors in the brain. Advances in treatment are changing that approach. Some targeted therapies and immunotherapies can treat certain brain metastases, depending on the type of cancer and its molecular characteristics. 

For example, a tumor with a particular genetic mutation may respond to a medicine designed to target that mutation. Not everyone has a mutation for which a targeted treatment is available. When one is identified, however, systemic therapy may help treat cancer in the brain and elsewhere in the body. 

Often, the question isn't which single treatment to use but which combination to use and in what order. For example, surgery may be recommended first to relieve symptoms or obtain tissue for testing, followed by focused radiation. Chemotherapy, immunotherapy or other medicines also may play a role in treating cancer throughout the body. 

Because these decisions are complex, treatment planning often involves specialists from neurosurgery, medical oncology, radiation oncology and other areas. Ask your healthcare team what each treatment is intended to accomplish, why the treatments are being recommended in a particular order and how the plan reflects your priorities. 

Although there is no one-size-fits-all approach, a coordinated evaluation can turn a complicated set of choices into a clearer path forward. 

Ian Parney, M.D., Ph.D., Neurosurgery, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: What are the treatment options for brain metastases? appeared first on Mayo Clinic News Network.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:00) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Screening for prostate cancer can start with a blood test. A prostate-specific antigen, or PSA, test measures a protein produced by the prostate. An elevated level may indicate the need for further evaluation.

"Screening is important because the earlier you catch prostate cancer, the higher the likelihood of cure," says Dr. Albert Attia, a Mayo Clinic radiation oncologist.

Knowing when to begin screening is an important conversation to have with your healthcare team.

"Screening is recommended for men at the age of 50, and some data indicate it's better to get screened even at age 45, especially if you have a family history of prostate cancer," Dr. Attia says.

There are several treatment options when it comes to prostate cancer. Surgery, hormone therapy, radiation or a combination of those may be used.

One radiation option is intensity-modulated radiation therapy, or IMRT. The goal is to precisely target the tumor while limiting radiation to nearby tissue.

"This is a way for us to shape the dose of radiation to deliver the high dose areas to the tumor and avoid any critical structures nearby," says Dr. Attia. "We're able to achieve submillimeter accuracy."

Join the conversation at the Mayo Clinic Connect Prostate Cancer Support Group.

The post Mayo Clinic Minute: Early screening and treatment advances improve prostate cancer outcomes appeared first on Mayo Clinic News Network.

This aggressive brain cancer can extend beyond what's visible on a standard MRI, making it difficult to precisely target treatment. Just 5% to 7% of patients survive five years after diagnosis. 

Mayo Clinic researchers are studying advanced imaging techniques designed to bring more of the tumor into view and potentially give care teams a better-defined target. 

"We're trying to develop and improve treatments that will help extend the length of time patients live, as well as their quality of life and function while they're alive," says Dr. William Breen, a radiation oncologist at Mayo Clinic. "From a radiation perspective, we need to be able to accurately see the tumor to accurately target it and treat it as well as possible." 

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:04) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Seeing tumors more clearly 

A standard MRI with contrast shows doctors where glioblastoma appears to be, but tumor cells can extend into the surrounding brain beyond what is clearly visible. 

"In over half of patients, we find a tumor more than a centimeter beyond the standard MRI-defined tumor, and in 20% of patients, we find a tumor more than 2 centimeters beyond the standard MRI-identified tumor," Dr. Breen says. 

To see more, Mayo Clinic investigators are combining advanced MRI techniques with research PET scans. The scans provide different clues, such as areas where cells are especially dense, where blood flow is increased or where there may be more aggressive tumor activity. 

Together, they can give doctors a more detailed picture of the tumor and where it may extend. 

Treating tumors more precisely and effectively 

Because glioblastoma can extend beyond what doctors see on a traditional MRI, radiation treatment generally includes an extra margin around the visible tumor to help cover cancer cells that may be hidden. 

Advanced imaging could help doctors more accurately identify those areas and tailor radiation accordingly. For some patients, that could mean treating a smaller area of the brain and reducing radiation exposure to healthy tissue. 

"By using advanced imaging, we're able to treat a smaller area in many patients and reduce the amount of normal brain receiving radiation, which may make for a safer and better treatment," Dr. Breen says. 

Researchers also are studying whether they can direct more intensive treatment toward areas that advanced imaging identifies as particularly concerning. 

Greater precision may make it possible to give a higher dose of radiation at each treatment and finish therapy sooner. Dr. Breen says treatment has been shortened from three to six weeks to one to two weeks for some patients, meaning fewer trips to the hospital and more time at home. 

Bringing specialties together 

The research brings together experts across Mayo Clinic, including neurosurgeons, radiation oncologists, neuro-oncologists, neuroradiologists and nuclear medicine specialists. 

"I think our strength at Mayo Clinic for treating glioblastoma is the multidisciplinary team," Dr. Breen says. 

While glioblastoma remains challenging to treat, advances in imaging, surgery, radiation, chemotherapy and other therapies are helping researchers continue to improve care. 

"We know there's still much progress to be made," Dr. Breen says, "but we have seen progress over the years to improve both quality of life and quantity of life for our patients with glioblastomas."

The post Mayo Clinic Minute: Seeing glioblastoma more clearly could improve how it’s treated appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I have a friend who was diagnosed with ovarian cancer, but she didn't have any obvious symptoms. What are some signs or symptoms women should pay attention to and get checked out? 

ANSWER: Unfortunately, ovarian cancer can be a difficult-to-detect disease early on because its symptoms often are vague and easily mistaken for common digestive, urinary or gynecologic problems. Many of the symptoms are things women experience from time to time. 

The key is to recognize when something has changed. Occasional indigestion or bloating usually isn't a reason for alarm. But when a symptom is new, different from what's normal for you or doesn't go away, it's important to pay attention to it and have a talk with your healthcare team. 

Five signs that can be easily overlooked and brought up when you see your healthcare team: 

1. Persistent heartburn or indigestion

Heartburn is common, so it's easy to reach for an over-the-counter antacid and move on. But persistent indigestion sometimes can be associated with ovarian cancer. In the past, ovarian cancer symptoms were described as being "hidden" by prolonged antacid use because women might treat what seems like routine heartburn for months without investigating why it continues. That doesn't mean heartburn is usually cancer. It means persistent digestive symptoms that don't settle down deserve attention rather than repeated self-treatment. 

2. Bloating or abdominal fullness

Most people experience bloating occasionally. With ovarian cancer, however, a woman may notice ongoing bloating or a sense of fullness in her abdomen that wasn't there before. The sensation may be difficult to describe. Because this symptom can develop gradually, it may be easy to dismiss.  

3. Feeling full after eating only a small amount

A woman may sit down for a meal and find that after only a few bites, she feels as though she's eaten enough. It could be a concern if this happens repeatedly and represents a change in appetite or eating pattern. 

4. Changes in urination

Ovarian cancer also can cause symptoms that seem more likely to be related to the bladder. A woman may need to urinate more frequently or feel as though her bladder hasn't completely emptied after going to the bathroom. Urinary changes can have many causes, but new or ongoing changes deserve attention. 

5. Changes in bowel habits

A woman who has been fairly regular throughout her life may suddenly notice more constipation, occasional diarrhea or another significant change in bowel habits. As with the other symptoms, an isolated episode generally isn't a concern. 

Changes in menstrual cycles also shouldn't automatically be dismissed. Irregular cycles can be common during perimenopause and menopause. While menstrual changes are more commonly associated with uterine, endometrial or cervical cancers, ovarian cancer also can be associated with changes such as more frequent or heavier cycles or increased menstrual pain. 

With ovarian cancer, awareness is particularly important. By the time symptoms become noticeable, the cancer may no longer be at an early stage. There also isn't a routine ovarian cancer screening recommendation for the general population comparable to mammograms for breast cancer or screening for colorectal cancer.  

Tests such as the CA-125 blood test and pelvic ultrasound can be useful in certain situations, including for some people at higher risk, but these tests have limitations and can produce false-positive or false-negative results. 

Women are at higher risk if they: 

• Are older. 

• Have inherited gene changes, including BRCA1 and BRCA2. 

• Have several other gene changes known to increase the risk of ovarian cancer, such as those associated with Lynch syndrome and the genes BRIP1, RAD51C and RAD51D. 

• Have a family history of ovarian cancer.  

• Are overweight or obese.  

• Are undergoing postmenopausal hormone replacement therapy.  

• Have endometriosis. 

• Began menstruation early or late.  

• Have never been pregnant. 

The most important takeaway is to know what's normal for your body. Digestive discomfort, bloating and urinary changes are common and usually aren't caused by ovarian cancer. But if you have symptoms that are new, persistent, distinctly different from your usual pattern or don't feel right, talk with your healthcare team. An evaluation can help determine the cause and whether additional testing is needed. 

Sandeep Basu, M.D., Breast Cancer Care, Hematology and Oncology, Mayo Clinic Health System, Eau Claire and Menomonie, Wisconsin 

The post Mayo Clinic Q&A: What are 5 ovarian cancer signs women may overlook? appeared first on Mayo Clinic News Network.